1. Peripheral Nervous System 1: The Somatic System 21 July 2014 Reading: Moore’s ECA5 27–33 ECA4 31–36 Grant’s Atlas 12 2009 Lawrence M. Witmer, PhD Professor of Anatomy Dept. of Biomedical Sciences Heritage College of Osteopathic Medicine, Ohio University Athens, Ohio 45701 witmerL@ohio.edu

2. Dichotomies 1. Tissues: neurons vs. glia 2. Position: CNS vs. PNS 3. Function 1: sensory vs. motor 4. Function 2: somatic vs. visceral Gray’s Anatomy 38 1999 neuron glial cell

3. Neurons Moore’s COA6 2010 cell body axon with myelin sheath Schwann cell dendrites synapses Dendrites: carry nerve impulses toward cell body Axon: carries impulses away from cell body Synapses: site of communication between neurons using chemical neurotransmitters Myelin & myelin sheath: lipoprotein covering produced by glial cells (e.g., Schwann cells in PNS) that increases axonal conduction velocity Demyelinating diseases: e.g., Multiple Sclerosis (MS) in CNS or Guillain- Barré Syndrome in PNS

4. CNS vs. PNS Moore’s COA6 2010 Central Nervous System brain & spinal cord integration of info passing to & from the periphery Peripheral Nervous System 12 cranial nerves 31 pairs of spinal nerves Naming convention changes at C7/T1 Collection of nerve cell bodies: CNS: nucleus PNS: ganglion

5. Sensory (Afferent) vs. Motor (Efferent) e.g., skin e.g., muscle Gray’s Anatomy 38 1999 sensory (afferent) nerve motor (efferent) nerve (pseudo-) unipolar neurons conducting impulses from sensory organs to the CNS multipolar neurons conducting impulses from the CNS to effector organs (muscles & glands)

6. Somatic vs. Visceral attributeSomatic SystemVisceral System embryological origin of tissue “body wall:” somatic (parietal) mesoderm (dermatome, myotome) “organs:” splanchnic (visceral) mesoderm, endoderm examples of adult tissues dermis of skin, skeletal muscles, connective tissues glands, cardiac muscle, smooth muscle perceptionconscious, voluntaryunconscious, involuntary Langman’s Embryo 9 2004

7. Sensory/Motor + Somatic/Visceral SomaticVisceral Sensory (Afferent) somatic sensory [General Somatic Afferent (GSA)] visceral sensory [General Visceral Afferent (GVA)] Motor (Efferent) somatic motor [General Somatic Efferent (GSE)] visceral motor [General Visceral Efferent (GVE)] SomaticNervousSystem (today) AutonomicNervousSystem (August 4)

8. Structure of the Spinal Cord Moore’s COA6 2010 meninges pia arachnoid dura arachnoid pia meninges ventral root white matter (axons) gray matter (cell bodies) dorsal (posterior) horn ventral (anterior) horn ventral rootlets dorsal rootlets dorsal root (spinal) ganglion spinal nerve dorsal primary ramus ventral primary ramus subarachnoid space (CSF) denticulate ligament

9. Lower brachial plexus injuries Upper brachial plexus injuries Upper Brachial Plexus Injuries Increase in angle between neck & shoulder Traction (stretching or avulsion) of upper rootlets (e.g., C5,C6) Produces Erb’s Palsy Lower Brachial Plexus Injuries Excessive upward pull of limb Traction (stretching or avulsion) of lower rootlets (e.g., C8, T1) Produces Klumpke’s Palsy “Obstetrical” or “Birth palsy” Becoming increasingly rare Categorized on basis of damage Type I: Upper (C5,6), Erb’s Type II: All (C5-T1), both palsies Type III: Lower (C8, T1), Klumpke’s Palsy Moore’s COA6 2010 Rootlet Damage http://www.oucom.ohiou.edu/dbms-witmer/ Downloads/2003-09-17_Ortho_Anat.pdf

10. Structure of Spinal Nerves: Somatic Pathways dorsal root ventral root dorsal horn ventral horn dorsal root ganglion spinal nerve gray ramus communicans white ramus communicans sympathetic ganglion dorsal ramus ventral ramus somaticsensorynerve(GSA) somaticmotornerve(GSE) CNS inter- neuron CNS inter- neuron Mixed Spinal Nerve Nerve

11. Structure of Spinal Nerves: Somatic Pathways dorsal root ganglion ventral root spinal nerve dorsal ramus gray ramus communicans white ramus communicans sympathetic ganglion somaticsensorynerve(GSA) somaticmotornerve(GSE) CNS inter- neuron CNS inter- neuron Mixed Spinal Nerve Nerve ventral ramus Somatic sensations touch, pain, temperature, pressure proprioception: joints, muscles Somatic motor activity : innervate skeletal muscles dorsal horn ventral horn

12. Structure of Spinal Nerves: Dorsal & Ventral Rami spinal nerve dorsal ramus somaticsensorynerve(GSA) somaticmotornerve(GSE) ventral ramus Territory of Dorsal Rami (everything else, but head, innervated by ventral rami) Stern Essentials of Gross Anatomy

13. Impact of Lesions Disruption of sensory (afferent) neurons (paresthesia)somaticsensorynerve(GSA) somaticmotornerve(GSE)

14. Impact of Lesions Disruption of motor (efferent) neurons (paralysis)somaticsensorynerve(GSA)somaticmotornerve(GSE)

15. Impact of Lesions somaticsensorynerve(GSA) somaticmotornerve(GSE) Disruption of motor (efferent) neurons (paralysis) Disruption of sensory (afferent) neurons (paresthesia)

16. Impact of Lesions somaticsensorynerve(GSA) somaticmotornerve(GSE) Disruption of sensory (afferent) neurons (back paresthesia) Disruption of motor (efferent) neurons (paralysis of deep back muscles)

17. Segmental Innervation: Dermatomes & Myotomes Moore’s COA6 2010 somaticsensorynerve(GSA) somaticmotornerve(GSE) Dermatome: cutaneous (skin) sensory territory of a single spinal nerve Myotome: mass of muscle innervated by a single spinal nerve spinal nerve skin (dermatome) muscle (myotome)

18. Segmental Innervation: Dermatome Maps Based on clinical findings of deficits in cutaneous sensation Diagnostic aids: localization of lesions to cord levels Limits to specificity due to overlap of dermatomes Moore’s COA6 2010 dermatome overlap

19. dorsal root ganglion Dermatomes & Herpes Zoster (“Shingles)” Chicken pox virus (varicella) infects dorsal root ganglia Once activated, travels along afferent axons to skin where it forms very painful rash Often has a typical dermatomal presentation

20. Segmental Innervation: Myotome Maps Grant’s Atlas 12 2009 Particular functions are linked to muscles innervated by particular cord levels Example: C5 lesion Weakness in flexion of elbow & shoulder Weakness in abduction & lateral rotation of shoulder ROTATION ABDUCTION FLEXION

21. PNS Plexus Formation cervical plexus C1–C5 brachial plexus C5–T1 lumbar plexus L1–L4 sacral plexus L4–S4 Dermatomes: single spinal nerve Peripheral nerves: multiple spinal nerves from different cord levels Plexus formation: mixing of nerves from different cord levels by union and division of bundles dermatome map map of named peripheral nerves disparity Moore’s COA6 2010

22. PNS Plexus Formation Brachial Plexus (C5–T1) Radial Nerve C5–T1 Example of named peripheral nerve Radial nerve receives fibers from spinal nerves from five different cord levels — in fact, all cord levels of the brachial plexus

23. PNS Plexus Formation ABDUCT & LAT. ROTATE FLEX Distribution of a single spinal throughout a plexus Myotome — return to the C5 lesion example Abduction: supraspinatus & deltoid Lateral Rotation: infraspinatus & teres minor Flexion: Biceps brachii & Brachialis Moore’s COA6 2010

24. References Agur, A. M. R. and A. F. Dalley. 2009. Grant’s Atlas of Anatomy, 121th Edition. Lippincott, Williams & Wilkins, New York. Bannister, L. H. et al. 1999. Gray’s Anatomy, 38th Edition. Churchill Livingstone, New York. Moore, K. L., A. F. Dalley, and A. M. R. Agur. 2010. Clinically Oriented Anatomy, 6th Edition. Lippincott, Williams & Wilkins, New York. Sadler, T. W. 2004. Langman’s Medical Embryology, 9th Edition. Lippincott, Williams & Wilkins, New York. Stern, J. T., Jr. 1988. Essentials of Gross Anatomy. Davis, Philadelphia.